Tag Archives: Hair Transplants

Here’s our latest Q&A with Dr. Arocha regarding donor harvest. If you have a question for Doctor Arocha you would like answered on our blog, please email us with your question.

Q. Hi, Doc. I’ve been researching hair-transplantation, and I have a question concerning F.U.T. (strip-harvesting): I understand, in this method, a strip is excised from the back of the scalp, the wound then closed. I wonder, then, is not the overall surface of the scalp reduced in this procedure? After two or three procedures, especially, (or even after one large session) — when, totally, a reasonably wide portion of the scalp has been removed, will not a patient’s hairline, in accordance, also be shifted?

That is, the front hairline would move back by the amount of scalp excised, or, more likely, the “rear hairline” (which ends at the back of the neck) must certainly be “moved upward.” At least, this is how I imagine it would be. Is my logic flawed? I’ve been trying to understand this in researching the procedure, but the point still evades me.

I understand a physician will take into consideration laxity of the scalp, so what I’m talking about might not be immediately noticed — I also hear doctors will try to cut out strips that are longer rather than wider, to reduce tension — but, ultimately (again, especially when a large number of grafts must be harvested), will not the hairlines (front and certainly rear) be affected?

If not, why not?

A. Initially, there is a temporary shortening of the donor zone. Note the change in the width of the posterior fringe, the after photo is taken immediately post-harvest after a 2 cm wide strip was removed.

The effect is short-lived as the tissue stretching back to it’s original dimensions, this is the aptly named stretch back.

Q. If so, is this effect permanent? The piece of scalp taken out can’t “regenerate,” can it (and, if it could, would it regenerate hair follicles, too)?

A. No,the removed follicles will grow in the transplanted location, but they will not regenerate.

Q. Can hair that’s already been transplanted to a new location be removed and successfully retransplanted in another area (e.g., back to front, then, later, if need be, north of that region)?

A. Yes, absolutely. I have transplanted chest hair to scalp, where it grew happily for months. Then later these transplanted chest hairs were removed and could have been transplanted anywhere on this patient.

Eyebrow hair loss can be a very traumatic experience for any individual no matter their age or gender. Statistics estimate that over three million Americans experience eyebrow loss in just one year. Eyebrows play such a crucial role on our faces. They frame the eyes and help to express the emotions we are feeling. Fortunately, there is an alternative to penciling in or tattooing eyebrows to restore a more natural result. In the Slideshare Presentation below, Dr. Arocha covers the eyebrow reconstruction procedure. Presentation includes surgical and before/after photos.

Grafting: A variety of procedures where hair-bearing skin is removed from the lower scalp at the back of the head-the “donor area”-and transferred to thinning or balding areas.

Hair Economics: A theory that states only a limited or decreasing supply of hair exists, but the demand for hair increases as balding patterns develop.

Hair Flaps: Techniques to rotate large portions of hair from the sides and back of the scalp to the front and central areas of the head. Most effective when used with a tissue expander. See also “Scalp Rotation Flaps.”

Hair Follicle: A strand of hair and its root which is extracted from the donor area and transplanted to the recipient area during hair restoration surgery.

Hair Grafts: Hair follicles that have been harvested from the donor area and are ready for transplantation into the recipient area of the scalp. The numbers of hair follicles per graft vary widely depending upon the transplantation technique used. A graft may contain a single hair follicle, a single follicular unit, multiple follicular units, or even 20 or more follicles (as in a large round graft).

Hair “plugs”: A slang term typically used to describe the large round grafts that were used more commonly years ago.

Hair Transplant: A surgical technique that transfers hair follicles from the donor area to the recipient area.

Hairline Refinement: or “Hairline Correction” refers to the use of a variety of newer, more delicate grafting techniques to alter, camouflage or soften the “pluggy” looking results of older hair transplant techniques.

Example of one of Dr. Arocha's patients with a transplanted hairline that looks undetectable.

Male Pattern Baldness: An inherited condition in men which is triggered by the hormone Dihydrotestosterone which causes gradual miniaturization (and eventual loss) of hair follicles. Starting anytime after puberty with a recession of the hairline and thinning of the crown areas, it can eventually lead to complete baldness at the top of the scalp. The areas around the sides and back of the scalp are not typically affected by male pattern baldness.

Micrograft: A graft containing 1 or 2 hairs, obtained from the donor area with a micropunch or sliced off from a round graft (see below). A micrograft is typically placed into holes made in the scalp with a microneedle or punch.

Minigraft: A graft containing 3 or 4 hairs (small minigraft) or 5 or 6 hairs (large minigraft). There are many variations of minigrafts derived from round grafts.

Multi-unit grafts (MUG): Grafts that contain two or more follicular units in a single graft. This term replaces the older “minigraft”. In practice today, MUGs contain 2-6 follicular units per graft.

Multi-unit grafting: Hair transplantation using multi-unit grafts. In practice, these grafts may be placed into small round holes, slots, or slits. This would always be in combination with the use of FUT in the same procedure.

1. Caliber: referring to the actual size of the hair shaft. Coarse hair provides better results in one session than fine hair. For example, if we go from fine hair with a diameter of 40 microns to coarse hair with a diameter of 80 microns, the area covered increases TWELVE fold. Since the hair shaft is a circle the area is ∏r2 hence (3.14)(2)2= 3.14x 4≥12. Caliber is the single most important factor to consider when deciding on the number of follicular units to transplant.

Here’s some simple examples of #1 and #2:

Real life examples:

*All patients had the same amount of follicular units transplanted (2500)

2. Texture: curly, wavy, frizzy or stick straight, your hair characteristics also contribute to the amount of perceived coverage. Wavy and curly hair will cover more area than fine, straight hair. African-American hair covers a greater volume and more than compensates for the lower hair density in this race. (see above illustration)

3. Contrast: the color of the hair compared with the skin tone of the individual. Black hair looks thinner on fair skinned individuals, but thicker on someone that has a darker complexion. The less contrast, the thicker the hair will look.